Does high-frequency oscillatory ventilation (HFOV) improve survival in ARDS? The OSCAR trial evaluated the efficacy of HFOV compared to conventional ventilation in patients with acute respiratory distress syndrome (ARDS). This multicenter randomized controlled trial (RCT) enrolled over 800 patients with moderate-to-severe ARDS. The results showed no significant difference in 30-day mortality between the HFOV and the conventional ventilation groups. Additionally, HFOV was associated with a higher risk of adverse events, including hemodynamic instability. The findings suggest that HFOV does not confer a survival benefit in ARDS and should not be routinely used as a first-line ventilation strategy.